REMOTE STORAGE 


[Reprinted from American Medicine, Vol. X, No. 12, pages 486-487, 
September 16, ”1905.] 


EMOTIONAL SHOCK AND FRIGHT «. “AS: CAUSES OF 
EPILEPSY. 


BY 
WILLIAM P. SPRATLING, M.D., 
of, SonyedN. 26 


Medical Superintendent of the orate Colony for Epileptics; President of 
the National Association for the Study of Epilepsy; Member 
New York Academy of Medicine; American Neuro- yo sya 


logical Association, etc. oo Se 


posts 
te: 


The casual student of epilepsy may hesitate to believe 
that epilepsy is so often due to emotional shock and 
fright as reliable data-conclusively show. 


Féré declares it is beyond doubt that in predisposed , 
subjects a fit may be immediately provoked by a more | 
or less intense. shock™to° thé*™ nervous. system, and that © 


such states are ciated with an overexcitability favor- * 


able to the evolution of convulsive phenomena. At the 
menstrual periods these emotions act even more power- 
fully by reason of the nervous susceptibility which 
accom panies this physiologic condition. The convul- 
sive discharge may gccur immediately after the emotion 
is experienced, or‘be delayed for some time after. 


The nervous depression succeeding emotional shocks ° 


may last a good while, and the attack may “alter thes 
during the asthenic state, occasionally long eae 
initial cause. An epilepsy which manifests 
connection with fright may become definitel #i 
lished and the fits may thereafter appear without appar- 
ent exciting cause. 

In some instances the attack invariably recurs when 
the same exciting influence is applied ; for instance, the 
sight of a corpse, of a precipice, of blood from an injury, 
ec. 


/ot all the immediate causes of epilepsy the most potent are 
physical fright, excitement, anxiety. To these are ascribed 
more than a third of those in which a definite cause is given. 
Of the three forms of emotion, fright takes the first place. The 
relation of this cause to age is very distinct. It is effective 
chiefly in early life, when emotion is so readily excited, and is 
most powerful at the transition from childhood to adult life, 
while after middle life it is almost inactive.’ The female sex is 
nctoriously the more emotional, and accordingly the disease 


ave 


& 


2 


results from fright in a larger proportion of women than of 
men, although the difference is, perhaps, less than might be ex- 
pected—61% of women and 39% of men. It is notorious also 
that this difference between the sexes increases as life advances. 
In childhood one sex is almost as emotional as the other, but 
with puberty men become far less emotional than women. The 
influence of fright as a cause of epilepsy is in strict harmony 
with this fact. Under 10 the sexes suffer equally. Between 
10 and 20 the male suffers less than the female, as 3 to 4; 
between 20 and 30, as 3 to 13, and over 30 the only cases due to 
this cause occur in women. 

Predisposition usually exists. Hence, in speaking of 
fright as a cause of epilepsy, it must be remembered (as 
alrons stated) that its effects are only that of the exciting 
spark. 

“The exact form of fright varies, of course, in different 
cases, but the list is instructive. In several cases, the cause 
was some stupid, practical joke—a pretended ghost, children 
shut up in dark cupboards, an alarm of fireor burglars. Ina 
few cases, the patient had watched other persons in fits. Alarm - 
during severe thunderstorms was another cause. One case was 
that of a soldier, who had his first fit a few hours after being 
terrified, while on sentry duty at night, by the unexpected 
appearance of some white goats on the top of the adjacent walls 
of a cemetery, which he mistook for emissaries from the 
graves.”’ (Gowers.) 


In a study of 1,828 cases, I found emotional shock or 
fright to have been the cause in 62, or 5.56%. Of these, 22 
were men, in a total of 814, and 40 were women, ina 
total of 509, being about 8% among the former and 
nearly 8% among the latter, showing such causes to be 
nearly three times as active among women as among 
men. 

During the first 10 years of life, there were 14 cases 
due to this cause among 814 men, and 15 among 509 
women, which demonstrates the greater susceptibility of 
. females even at this early age. 

Some writers state there is no difference in the sexes 
during the earlier years, but such is not my experience. 
During the second 10 years, only 7 cases occurred among 
the same number of men, whereas there were 25 among 
the women. After 20 years, there was one case only in 
either sex. It seems, therefore, that emotional shock 

‘most often leads to epilepsy in the female sex, and is 
“most apt to be active about the age of puberty. 

It is interesting to note the influence of heredity 
in these cases at the three age periods mentioned. 
Under 10 some hereditary influence was present in 5 
boys and not present in 9. Between 10 and 20 it -was 
present in 2 and not presentin 3, while it was not present 
in a single case after 20, thus making it a factor in 7 
cases only out of 22 among the men. Under 10 it was 


REMOTE STORAGE 


present in 10 girls and not present in 4; between 10 and 

—. 20 it was present in 14 and not present in 11, while it 
was noted in only 1 case after 20 (and that at the forty- 
fifth year), thus making it a factor in 20 cases out of 40 
among the women. 

The character of the Gaetan shock of fright is indi- 
cated in the following: ‘‘ Fright from seeing an escaped 
lunatic’’; ‘‘ frightened by a Sees en father’’; ‘‘from 
seeing blood’’; ‘‘from a dog “bite’’; ‘‘from being 
chased by a cow,’’ etc. 

Asan illustration of the type of case in which emo- 
tional shock produces epilepsy, the following is a typical 
instance : 


L. L. had the first convulsion when she was a girl of 9, due 
‘“to seeing an escaped lunatic.’’? She has always been ‘‘ very 
emotional and easily excited.’”’ She had7 or 8 attacks at first 
every 24 hours, which condition persisted for some years; then 
they dropped to4or5a day until 1896, when she was 24. At 
that time they began to appear several days apart. At first 
they were entirely petit malin character, but later changed to 
‘grand mal, with no aura. She has always fallen in such a way 
as to injure her face, having several times fractured her nose, 
and more than once her lower jaw. If there ever was an ele- 
ment of hysteria in her attacks it disappeared completely years 
ago, for she is a typical epileptic at this time, bearing in her face 
the only physical signs pathognomonic of the disease—a mass 
of scars acquired through repeatedly falling and injuring the 
“~~ Same place—a part of the only true facies epileptica. 


It sometimes happens that when the disease is caused 
through undue excitation of the psychic centers, the 
“~~ reapplication of the same excitation will produce an 
: attack. There is now under my care a girl of 14 whose 
epilepsy appeared when she was 12, and was caused 
through fright on hearing the fire-alarm, and seeing the 
fire-engines go by in the night. While under my care 
“there have been two occasions when she has heard similar 
_ alarms, and each time she had an attack. 
This is a logical result for the unconscious association 
of ideas, and the results they produce are as definite in 
action as it is possible for memory associations to be. 


A man who sat in Ford’s theater in Washington the night 
Lincoln was assassinated saw the assassin enter the box in 
which the President sat; saw the flash of the pistol-shot, and 
witnessed the confusion that followed. Immediately in front 

_Sat a lady who wore a bunch of heliotrope on her dress—a flower 
of intense perfume. He caught the odor of this flower at the 
moment he saw the pistol fired and heard the noise, and for 30 
years thereafter, when he told me the story, he never smelled 
the odor of heliotrope without seeing the whole tragic scene 

; ae as distinctly as it was presented to him on that fateful 
night. 


So it is that the sensory stimulation of any center or 
faculty that is organized into a definite action may be 
produced indefinitely under the reapplication of the 
same or similar causes. 

‘‘'There is,’? says Thomas Watson, ‘‘another very 
singular occasional cause of epilepsy that deserves to be 
mentioned, namely aie sight of a person in a fit of that 
disease.’ 

Watson asserts that this fact has been noted time and 
again; that patients who already have the malady will 
fallina convulsion at thesight of another one ; that those 
who were previously affected may acquire the disease in 
this way; and even that the disease will ‘‘ now and then 
run through a boarding school or through the ward of a 
hospital.”’ 

Watson speaks of the possibility of these attacks be- 
ing due to imitation, or to feigning, or most likely to 
hysteria, but finally declares they are epileptic. 

I dissent unreservedly from the view of this writer 
that epilepsy may become epidemic in schools and in 
hospitals. Instances of the kind that Watson mentions 
should unquestionably be classed as due to hysteria ; I do 
not for a moment doubt the power of an epileptic 
attack to excite a seizure in another epileptic, though it 
is comparatively rare. The constant association of epi- 
leptics, sensitive at first in this way, with other epilep- 
tics who have frequent seizures, causes them in time to 
lose such sensibility entirely. 

Shortly after a large number of epileptics of all types 
and characters had been brought together very nearly 
100 of them had to eat ina common dining-room. A 
violent seizure occurred at one of the dinner tables one 
day; the table was knocked over, and crockery and 
chairs smashed amid great noise and confusion. In a 
few seconds four other epileptics were in convulsions. 

But it was not long before the occurrence of a fit in 
this room lost all power of causing attacks in others. It 
is the primary shock that does the damage. 

A nurse reported an instance in which a man had a 
violent attack at midnight and awakened his compan- 
ions about him, three of whom at once had epileptic 
convulsions. None of them were hysteric in any 
degree, the shock of sudden fright having brought on 
the attacks. 

I recall two instances in which a young woman went 
into convulsions at the sight of a companion so affected, 
the attacks in both instances having occurred at night. 


5 


It has also been observed that when epileptic men 
and women meet in the same room for religious worship, 
or amusement, both sexes have more attacks proportion- 
ately than when one or the other attends alone. The 
reason for this is found in the psychic stimulation of 
passion, a recognized exciting cause in some cases. 

According to Mosso, Pinel always began the examin- 
ation of a patient by asking him whether he had not 
had some fright or great vexation. The same author 
states that through the vivid impressions, emotions may 
produce, the same effects may be sustained, as, for 
instance, through a blow on the head or some physical 
shock. Fear causes the loss of consciousness, sight, and 
speech. 

Beger reports the cases of two perfectly healthy old 
men, one 65 the other 70, who had epileptic fits immed- 
iately after being frightened, though they had never 
suffered in that way before, nor were they predisposed 
to such a disease. 

Kohts, in his account of the maladies caused by 
fright during the siege of Strasburg in 1870, gives a 
minute description of the cases of paralysis agitans and 
of convulsions which he observed; while we find 
numerous references in Hack Tuke’s ‘ Dictionary of 
Psychological Medicine’”’ to the emotional state as a 
cause of epileptic attacks. 


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